Afghanistan

I have been watching the Ashoka Healthy Mother Competition with interest. Maternal Health is one of my passions; I studied it in graduate school and it has been part of my work for the last ten years. The ideas submitted to the competition have ranged from half-considered flashes of thought to fully imagined comprehensive maternal health programs. I am an advisor to one of them – AYZH, a social venture that works to provide clean, green birth kits to women in India.

It will not surprise you, then that I would love to attend the 2010 Maternal Health Change Summit in India. This post is my entry in the contest to attend the summit. I’m not going to talk about AYZH here, because it doesn’t seem quite fair to write about something so close to my heart in this context.

Instead, I will write about Sakeena Yacoobi. Founder of the Afghan Institute of Learning (AIL), she is one of the true heroes of this world. An Afghan-American, she returned to Afghanistan to serve women in her country of birth. The Afghan Institute of Learning offers services from basic education to human rights leadership training for 350,000 women and children in Afghanistan. They supported underground schools during the Taliban regime.

They also offer health care and health education. AIL is the provider of medical care for thousands of Afghan women. They use a family health approach, focusing on education and preventative care as well as medical services. When you are dealing with maternal health, it’s the gold standard. Women need knowledge in order to have a health pregnancy, not just skilled care when giving birth.

One of the most interesting things about maternal health is the range of interventions we have to improve it. We need both innovations like better incubators for premature infants and well-known essentials like educating mothers, supporting maternal nutrition, and skilled personnel to accompany births.

AIL offers those essentials, to women who have no other options. Maternal mortality rates in Afghanistan are staggering. 18 mothers out of every thousand die as a result of motherhood; the second highest rate in the world. The three clinics of the Afghan Institute of Learning are helping to bring that number down, and they deserve our support to do it.

Humanitarian neutrality is dead. The sooner we stop mauling its rotting corpse, the better off we’ll all be. In fact, I don’t believe humanitarian neutrality ever existed. It’s not a corpse at all; it’s a figment of our imagination that we’re finally abandoned. The provision of humanitarian aid changes the dynamics of a conflict situation. It is therefore inherently not neutral, and it was naive to ever believe it could be.

Mary Anderson started talking about do no harm in 1994, and recognized that aid has an impact on the conflict, and is therefore never neutral. It was naive of us to ever pretend it was. Here’s what she had to say: “All aid programmes involve the transfer of resources (food, shelter, water, health care, training, etc.) into a resource-scarce environment. Where people are in conflict, these resources represent power and wealth and they become an element of the conflict.”

The targeting of NGO workers in places like Iraq, Afghanistan, and Somalia is appalling, and brutally dangerous. But what protected Medecins Sans Frontieres and the International Rescue Committee in Afghanistan in the 90s was not some airy-fairy belief in neutrality. It was the Taliban’s belief that the NGOs were not keeping the Taliban from achieving its goals. Combatants in Afghanistan no longer believe that, or are not organized enough to enforce rules. Mourning the end of neutrality is a dangerous sidetrack that keeps the real issue from being addressed.

All of that being said, I think that a particular NGO or project can nonetheless be known as honest and fair and therefore have a humanitarian space to operate in. But that’s not based on an abstract concept of neutrality or humanitarian space. It’s based on earning the trust and respect of local populations, and on convincing all sides of the conflict that your provision of aid will not turn the tables against them. That’s not an easy game to play, but it’s the only one we have. And, despite histrionics to the contrary, it’s the only game we’ve ever had.

Two Afghan aid workers just went missing north of Kabul. It is assumed they were kidnapped. Afghanistan’s really bad territory for aid workers, we all knew that. But it hits home every time I read something like this.

“Humanitarian-type people are attracted to the disaster circus, but we are beyond that here. It’s not a chronic crisis, but it’s not post-conflict either.”

I am not surprised by the staffing shortage. The world is full of altruistic adrenaline junkies who’ll go to a war zone if they can save people’s lives. It’s also full of warm fuzzy world savers who’ll spend 30 years teaching a village to grow their prickly pears more efficiently. What it’s not full of are people who want to do slow-speed capacity-building development work while also dodging bullets and kidnap attempts. The 50 people who do fit that profile probably all have jobs in Sri Lanka already.

I don’t really know what can be done to improve the staffing for development work in Afghanistan. Pay better, I suppose, but then you run afoul of donors and create an image of a bunch of mercenaries.

It could also point to a issue about the fit between the work being done and the context. Maybe we should move beyond the stereotypes, and trust in community knowledge. Maybe, if no one will go there, we’re doing something wrong and we need to re-think the kind of aid that’s being given.

“I don’t think hope is relevant.” Sarah Chayes was a reporter for the Christian Science Monitor in Afghanistan. She stayed in Afghanistan and is now running a soap co-op which markets its products in the US. This interview with her about Afghanistan sums up most aid workers’ approach to the countries they are in. Bitterness about the government and a focus on getting their own work done.

Big Fat Important Disclaimer

NOTHING I SAY ON THIS BLOG REPRESENTS THE VIEWS OF USAID OR THE US GOVERNMENT. Everything written here is purely my personal opinion. The contents of this blog are the responsibility of me, Alanna Shaikh, and do not necessarily reflect the opinion of USAID or the U.S. Government.

Disclaimer

Everything written here is purely my personal opinion. The contents of this blog are the responsibility of me, Alanna Shaikh, and do not necessarily reflect the opinion of USAID or the U.S. Government.